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two layers of the epidermis are
- stratum corneum (horny cell layer)
- stratum germinativum (basal cell layer)
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three layers of skin are
- epidermis
- dermis
- subcutaneous
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primary skin lesions include
- macule
- papule
- patch
- plaque
- nodule
- wheal
- tumor
- urticaria
- vesicle
- cyst
- bulla
- pustule
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secondary skin lesions include
- crust
- scale
- fissure
- erosion
- ulcer
- excoriation
- scar
- atrophic scar
- lichenification
- keloid
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macule =
- solely color change
- flat and circumscribed
- ie freckles, measles, petechiae, scarlet fever
- primary lesion
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papule =
- something you can feel
- less than 1 cm diameter
- mole, wart
- primary lesion
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patch =
- macules that are larger than 1 cm
- ie vetiligo, monogoliam spot
- primary lesion
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plaque =
- papules collect to form greater than 1 cm
- psoriasis
- primary lesion
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nodule=
- solid elevated and hard
- larger than 1 cm
- may extend deeper into dermis than papule
- primary lesion
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wheal =
- superficial, raised, transient, and erythematous
- ie mosquito bite, allergic reaction
- primary lesion
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tumor =
- larger than a few cm
- primary lesion
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urticaria =
- hives
- wheal coalesce to form extensive reaction
- intensely pruritic
- primary lesion
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vesicle=
- elevated cavity containing clear fluid
- blister
- clear serum flow
- chicken pox, herpes zoster
- less than 1 cm
- primary lesion
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bulla
- larger than 1 cm Blister
- friction blister
- primary lesion
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cyst =
- encapsulated fluid filled cavity in dermis or subcutanous
- tensely elevated skin
- primary lesion
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pustule -
- turbid fluid(pus) in cavity
- impetigo acne
- primary lesion
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crust =
- thickened dried up exudate when pustules, vesicles burst or dry up
- scab
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scale =
- compact desicated flakes
- dry skin, psoriasis after it dries up
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fissure=
- linear crack with abrupt edges
- extends into dermis
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erosion =
- scooped out but shallow depression
- epidermis lost
- moist but no bleeding
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ulcer -
deep depression extending into dermis
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excoriation =
- self-inflicted abrasion
- scratching
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atrophic scar =
stretch marks
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lichenification=
- prolonged intense scratching produces this
- looks like surface of moss
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keloid =
- hypertrophic scar
- raised and thick scar
- higher incidence among blacks
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where are blood vessels in skin located
subcutaneous and up into dermis
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moon shaped white area at base of nail
lunule
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where skin and nail meet
nail groove
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questions to ask in subjective data about skin
- prvious history of skin disease (allergies, hives,psoriasis etc)
- change in mole
- change in pigmentation
- excessive dryness or moisture
- pruritus
- excessive bruising
- rash or lesion
- meds
- hair loss
- change in nails
- environ or occupational hazards
- self care behaviors
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additional history of aging adult
- changes in skin over last few years
- any dela in skin healing
- itching
- pain
- chages in feet or toenails
- falls
- diabetes
- PVD
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Equipment needed foe exam
- strong direct light
- cm ruler
- penlight
- gloves
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what to assess about color of skin
- general pigmentation
- widespread color change pallor, erythema, cyanosis, jaundice
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when insepcting and palapating skin you
- look at color
- temp
- moisture
- texture
- thickness
- edema
- mobility and tugor
- vascularity, bruising
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mobility =
ease of rising
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tugor=
rate at which skin returns to normal when pinched up
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what to assess on a lesion
- color
- elevation
- pattern or shape
- size
- location and distribution on body
- exudate
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how to assess hair
- color
- texture
- distribution
- lesions
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nails inspect and palpate
- shape, contour
- consistency
- color - capillary refill
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normal nail profile =
160 degrees
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curved nail profile
160 degrees or less
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early clubbing of nail profile =
180 degrees
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ABCDE
- assymmetry
- border
- color
- diameter
- elevation and enlargement
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annular shape =
- circular
- begins in center and spreads to periphery
- tinea corpea
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confluent shape
- lesions run together
- hives
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discrete shape and configuration
distinct individual lesions and remain seperate
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gyrate formation =
snakelike
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zosteriform =
- linear arrangement along a unilateral nerve
- herpes zoster (shingles)
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grouped =
clusters of lesions
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how often should you examine skin
once a month
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hemangiomas
- port wine stain(nevus flammeus)
- strawberry mark (immature hemangioma)
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telangiectases
- spider or star angioma
- venous lake
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lsions casue by trauma or abuse =
- pattern injury
- hematoma
- ecchymosis
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skin lesions associated with aids =
epidemic kaposi's sarcoma
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pediculosis capitis =
head lice
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Tinea caitis =
scalp ringworm
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seborrheic dermatitis =
cradle cap
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alopecia areata =
sudden round patches of baldness
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folliculitis =
superficial infection of hair follicle
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Paronychia
- red swollen tender inflammation of nail folds
- bacterial infection
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Beaus line =
- transverse furrow or groove in nail
- trauma that impairs nail growth
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habit tic dystrophy
- depression down middle of the nail
- caused by nail picking
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